HomeMy WebLinkAboutInv# 1155952633 - CONCENTRA MEDICAL CENTERS - 11/17/2022Concentfre
Tax ld: 15-21L4B2BAccount N33-L242003529
Invoice: 1155952633 Balance: $88.00
Bill To: City of Dania Beach
Attn: Linda Gonzafez
100 W Dania Beach Blvd
Danj-a, FL 33004-3643
PLEASE RETURN THIS
Name / SSN /
Date PO Number Birth date
INVOIGE
Remit To:
lnvoice Date:
Date Printed:
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
t7/02/2022 - tt/02/2022
7t/01 /2022
LOCatiOn: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Bfvd
Dania, EL 33004-3643
PORTION WITH YOUR REMITTANCE.
Charge
Description
Charge
Amount
Pmts /
Adjmnts
The Eoftowing Services Performed at CMC - MIA
7I/02/2022 Spencer, Wi1lie
Ft Lauderdafe
Non Reg UDS 5 Pn1 & BAT Post Acc
Breath Alcohol Test Post Acciden
Non Reg UDS 5 Panel Post Acclden
xxx-xx-
xx/xxlxxxx 53.00
35.00
Balance Due: $88.00
,m
Occupational HeaIth Centers
Remit To: of tire southwest, p.A.
Account N33-t242003529
tnv Date: tt/02/2022 - 1_t/02/2a22
We appreciate your busj-ness. You can now pay online at
https: //payments. concentra. com/. Onfine payments must be
made via credit card. PIease contact our Centraf Business
Office at 800-686-0468 for additional- information.
AAIEEO Employer PAYMENT DUE UPON RECEIPT
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