| Contact Information | |
|---|---|
| First Name | Susan |
| Last Name | Spitz |
| Address | 4809 Bromley Lane |
| City | Richmond |
| State | VA |
| Province | |
| Zip/Postal Code | 23226 |
| Country | United States |
| Home Phone | - |
| Work Phone | - |
| Fax | |
| susans126@hotmail.com | |
| Alternate Email | |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Susan - Spitz |
| Date of Injury | 07/11/03 |
| Type of Injury | Traumatic |