| Contact Information | |
|---|---|
| First Name | gary |
| Last Name | johnson |
| Address | 1309 parkwood |
| City | ypsilanti |
| State | MI |
| Province | |
| Zip/Postal Code | 48198 |
| Country | United States |
| Home Phone | 734 - 502-5704 |
| Work Phone | - |
| Fax | |
| fatalattractor69@aol.com | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | gary - johnson |
| Date of Injury | 2005 |
| Type of Injury | Obstetric |