PAYABLE AND REMIT TO: SURGICAL ASSOCIATES EDICAL CTR NEW YORK,NY 10087-0668 _ EFTA00317366 KXd Palm Beach Pathology- Thank you for choosing Palm Beach Pathology for your health care needs. Statement Date: Responsible Party: Account Number: Due Date: REQUEST FOR PAYMENT Summary of Account Total Charges

-envic;-su-y- - -- pago para evitar futuras facturas. Apreciarnos su pronta atencion. This statement is for lab tests your physician ordered from. Palm Beach Pathology on your behalf. We are not affillétet with your physician. The balance is your responsibílity. Please make payment in full using a payment method l