Bill To:


Josefina Rodrigo Santa Cruz
3 Burk Ct
Freeport, TX 77541

Services Rendered To:


Josefina Rodrigo Santa Cruz
3 Burke Ct
Jones Creek, TX 77541
POLICY# 967586493


*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND DENIED. THIS IS NOW YOUR RESPONSIBILITY. ***

Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient

    Josefina Rodrigo Santa Cruz
    3 Burke Ct
    Jones Creek, TX 77541
    POLICY# 967586493

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 288- Rosharon, TX

Subtotal $1,500.00
Total Due $1,500.00


Updated
June 9, 2023 @ 12:44 pm

Invoice updated by Geoffrey.

Updated
July 3, 2023 @ 2:50 pm

Invoice updated by Geoffrey.

Viewed
March 7, 2024 @ 2:45 am

Invoice viewed by 52.5.70.31 for the first time.