Documente Academic
Documente Profesional
Documente Cultură
P 0 Box 308
Orion, IL 61273-0308
(309)524-5337
866
1-~
30~6~5~~~~~~~~~~~~~~~~~~~~~~
Invoice Date
Ticket#:
Charges
4/15/2016
4/15/2016
4/15/2016
4/15/2016
04/25/16
Patient ID
AMOUNT PAID
BALANCE
$1,125.00
$210.00
$53.30
$19.00
Milage
Supplies
Charge Total :
$1,407.30
BALANCE
We do not have any insurance information on file. Please call or
send us a copy of your insurance cards . If this bill is related to an
auto accident, please send us the claim number, insurance
company, their address and phone number.
If you do not have insurance, we would also be happy to set up a
payment plan that will work for you .
Just give us a call.
$1 ,407.30