| Contact Information | |
|---|---|
| First Name | Anthony |
| Last Name | Collins |
| Address | 39 Columbia Road |
| City | Waterville |
| State | ME |
| Province | |
| Zip/Postal Code | 04901-5625 |
| Country | United States |
| Home Phone | 207 - 356-5778 |
| Work Phone | - |
| Fax | |
| audiodude1978@yahoo.com | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Anthony - Collins |
| Date of Injury | 07/21/1959 |
| Type of Injury | Obstetric |