| Contact Information | |
|---|---|
| First Name | John |
| Last Name | Glisczinski |
| Address | 33669 211th Ave |
| City | Le Center |
| State | MN |
| Province | |
| Zip/Postal Code | 56057 |
| Country | United States |
| Home Phone | 507 - 357-2259 |
| Work Phone | 507 - 357-8295 |
| Fax | |
| JGlisczinski@yahoo.com | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | John - Glisczinski |
| Date of Injury | 10091960 |
| Type of Injury | Obstetric |