| Contact Information | |
|---|---|
| First Name | Nila |
| Last Name | Nicholas |
| Address | 2318 Berkshire Labe |
| City | North Brunswick |
| State | NJ |
| Province | |
| Zip/Postal Code | 08902 |
| Country | United States |
| Home Phone | 443 - 9281116 |
| Work Phone | - |
| Fax | |
| Alternate Email | |
| Website Address | www.candywithatwist.com |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Nila - Nicholas |
| Date of Injury | 12/21/1977 |
| Type of Injury | Obstetric |