| Contact Information | |
|---|---|
| First Name | Joseph |
| Last Name | Cucurello |
| Address | 25a wharton brook drive |
| City | wallingford |
| State | CT |
| Province | |
| Zip/Postal Code | 06492 |
| Country | United States |
| Home Phone | 203 - 2849552 |
| Work Phone | - |
| Fax | |
| phatdoper822@sbcglobal.net | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Joseph - Cucurello |
| Date of Injury | 12/05/03 |
| Type of Injury | Traumatic |