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RADIOLOGY AFFILIATES OF CENTRAL NEW JERSEY

Viewing the bill for SUSAN STARK

Balance: $15.18

Receipt:

Provider: RADIOLOGY AFFILIATES OF CENTRAL NEW JERSEY

Patient: SUSAN STARK

Account Number: 40426

Payment Date: 06/30/2022 3:22 PM EST

Amount: $15.18

Reference Number: 2202197720220630

Merchant Id: 000022321576

Payment:

Method Description Amount

Credit **** 0275 (MASTERCARD) $15.18

*When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from

your account or to process the payment as a check transaction.

*Please print a copy for your records.

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