From:

Suite 5A-1204
123 Somewhere Street
Your City AZ 12345

admin@elverdedentalbraces.vivabraces.com

Invoice Number INV-0162
Invoice Date August 17, 2017
Total Due $-147.00
To:
Damarys Rivera Talavera
Hrs/Qty Service Rate/PriceAdjustSub Total
1 ORTHODONTIC $1,963.000.00%$1,963.00
Sub Total $1,963.00
Tax $0.00
Paid -$2,110.00
Total Due $-147.00

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