Amber Burns

 
 From: Stephanie Gonzales 
 Fax: 13154312310 
 To: 
 Fax: (431) 318-5315 
 Page: 2 of 20 
 03/15/2022 8:55 PM 
 POWERED BY 
 DaisyBill 
 From 
 Stephanie Gonzales 
 To 
 Subsequent Injuries Benefits Trust  
 Original Bill 
 Med Legal 
 patient 
 Amber Burns
 Billing Provider 
 MED-LEGAL 
 Claim Number 
 SIF31433158 
 D.O.S 
 13/21/04 
 Patient Control No. 
 1031db7316431-1 
 Charge Amount 
 $10,238.00
 DaisyBill.com 
 info@daisybill.com 
 (631) 831-7311 
 DaisyBill does not respond to incoming faxes. Please call or email.