| Contact Information | |
|---|---|
| First Name | James |
| Last Name | Fay |
| Address | 932 Madison Ave |
| City | langhorne |
| State | PA |
| Province | |
| Zip/Postal Code | 19047 |
| Country | United States |
| Home Phone | 215 - 8915571 |
| Work Phone | - |
| Fax | |
| jpixstix@comcast.net | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | James - Fay |
| Date of Injury | 2/12/06 |
| Type of Injury | Traumatic |