LaiSOrP

LaiSOrP IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Laboratory Bill BALANCE NOW DUE TAX ID; : 84-0611484 5 wit Taat nanaleatmet Ilw. Patient Name: Invoice Date: Payments made via an online banking service must include this invoice * tvoIce/Factura: 41581647 ) Amount Due: $367.00 06/02/17 711728612370 Important Notice THIS BILL IS FOR LABORATORY SERVICES REQUESTED BY YOUR PHYSICIAN. PAYMENT IN FULL IS EXPECTED UPON RECEIPT OF THIS INVOICE. SEE THE BACK FOR CREDIT CARD AND INSURANCE OPTIONS. TENEMOS AGENTES BILINGUE DISPONIBLES PARA ASISTIR. Summary of Activity Date of Service Desaiption Chars.: s Adjustments Medicare/ Medicaid Paid Insurance Paid Patient Paid WPORTANTE: Tenemos agentes bilingoes disponibles para asiVirfe. Llamenos ahem para resolver su situachon. 283.00 84.00 367.00 You Pay 283 00 84 00 $367.00 tabCorp reserves the ngtit to reuse laboratory services for failure to pay for past sonless. Only your doctor can answer questions regarding testing. diagnosis ana res..rts To request a copy of your laboratory report Cali =MO TEST PERFORMED BY 1ABCORPfl We accept the following credit cards: VISA Payment arrangements can be made with no additional fee ley ca mg 1-800-8454167 from Sam - 8pm EST Monday - Friday, or visit lall0Orp.00I111billing I IllIlIllIlIllIll 11111 11111 IlIllIlIllIllIl 11111 II III 11111 11111 1111 1111 Payments made via an online banking service must include Invoice # 41581647 Return this portion with payment DO NOT SEND CASH Make check or money order payable to: oratory Corporation of America Holdings Involce/Factura: 41581647 Amount Due: $367.00 www.labcorp.com/billing FAX x*** 7/172861 2370**** 1 0367004 EFTA00313693