Contact Information
First Name	michele
Last Name	smith
Address	50 chestnut grove road
City	watertown
State	CT
Province
Zip/Postal Code	06795
Country	United States
Home Phone	860 - 945-6408
Gender	Female
Injury Information
The injured person is	Child
Name of Injured	gabriele -
Date of Injury	12/18/2003
Type of Injury	Obstetric