STATEMENT
Thomas J. Magnani D.D.S. Telephone:
Alvin Grayson D.D.S.
7 West 51st Street ■ paying Wage art were re aroma VW OM 0.0.3 n MI "tea Na Gni
a out below
7th Floor Sand Na Para
New York NY 10019
Ord Snob
&raisin 310 Cab
Mr. Jeff Epstein C@w91 qcflubi Dale Account
P.O. Box 806
New York NY 10150 Remittance
NPORTAHT - PLEASE DETACH UPPER PORTION NOD RETURN WITH YOUR RE/CNC! TO NSURE CREDIT TO PROPER ACCOUNT
Date Patient Description Charges Credits Balance
ions Balance
i AI
Account Total 1,520.00
If payment has been sent, please disregard this statement - Thank You.
We accept credit cards You may complete a top part of
this statement, or call the office at
Current 30 Days 60 Days 90 Days 120+ Days
1,520.00 0.00 0.00 0.00 0.00
Thomas J. Magnani D.D.S. Alvin Grayson D.D.S. 7 West 51st Street 7111 Boor New York NY 10019
EFTA00640853