| Contact Information | |
|---|---|
| First Name | john |
| Last Name | Koster |
| Address | 30107 cr 435 |
| City | Mt. Plymouth |
| State | FL |
| Province | |
| Zip/Postal Code | 32776 |
| Country | United States |
| Work Phone | - |
| Fax | |
| pushrod243@aol.com | |
| Alternate Email | |
| Website Address | http://www.scootersperformance.com |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | john - Koster |
| Date of Injury | 08/29/99 |
| Type of Injury | Obstetric |