| 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 |