| Contact Information | |
|---|---|
| First Name | CHRIS |
| Last Name | STEVENS |
| Address | 521 S WELLER STREET #211 |
| City | SEATTLE |
| State | WA |
| Province | |
| Zip/Postal Code | 98104 |
| Country | United States |
| Home Phone | 425 - 531-0284 |
| Work Phone | 425 - -0284 |
| Fax | |
| INTERNOSX3@MSN.COM | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | CHRIS - STEVENS |
| Date of Injury | 03/19/04 |
| Type of Injury | Traumatic |