Martin Family Chiropractic, Inc.
831 Garden Avenue
Myerstown PA 17067
(616) 894-9455






 
Tammy Alspaugh
Box 206
Newmanstown, PA  17073





 
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Patient Statement
Wednesday, August 17, 2011

RPS-476: R hip pain (Commercial Insurance )

Amount Due $0.00

Please enter Check # or Credit Card # / Exp. Date
 

Paid Amount $____.___

Service Date - 01/10/11, Invoice #10577 (Pending Insurance)
Balance Forward Charges $94.00 Payments $0.00 Balance $0.00
Total Balance $0.00