Contact Information | |
---|---|
First Name | Shannon |
Last Name | Russell |
Address | P.O. Box 23852 |
City | Santa Fe |
State | NM |
Province | |
Zip/Postal Code | 87502 |
Country | -- |
Home Phone | 505 - 467-9243 |
Work Phone | - |
Fax | |
russellshan@yahoo.com | |
Alternate Email | |
Website Address | |
Gender | Female |
Injury Information | |
The injured person is | Self |
Name of Injured | Shannon - Russell |
Date of Injury | 08/18/10 |
Type of Injury | Traumatic |