| Contact Information | |
|---|---|
| First Name | Alex&Teri |
| Last Name | Jordan |
| Address | 3464 Mulcaster Rd |
| City | Mississauga |
| State | WV |
| Province | Ontario |
| Zip/Postal Code | L5L 5B3 |
| Country | Canada |
| Home Phone | 905 - 607-5604 |
| Work Phone | 416 - 891-1896 |
| Fax | 416-237-1392 |
| wajracer@aol.com | |
| Alternate Email | bruell@bellnet.ca |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Child |
| Name of Injured | Rebecca - |
| Date of Injury | 05/18/2005 |
| Type of Injury | Obstetric |