Bill To:


HUDSON INSURANCE
PO Box 6818
Scranton, PA 18505-6818

Services Rendered To:


Asphalt Transport Inc.
17311 Market Street
Channelview, TX 77530
Policy # HMU200095-05


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

    Patient:

    Rafael Segovia
    1706 Oak Manor Drive
    Huffman, TX 77336

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA w/Entrapment Response

    Incident Location: MM 224.5 Northbound on IH 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization # 7

Subtotal $1,500.00
Total Due $1,500.00


Updated
March 30, 2022 @ 5:40 pm

Invoice updated by Geoffrey.

Updated
January 26, 2023 @ 1:30 pm

Invoice updated by Karen Smith.

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January 26, 2023 @ 1:30 pm

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.

Updated
January 26, 2023 @ 1:30 pm

Invoice updated by Karen Smith.

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January 26, 2023 @ 1:31 pm

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February 24, 2023 @ 10:23 am

Invoice viewed by Karen Meder - Smith (KarenS) for the first time.