| Contact Information | |
|---|---|
| First Name | Erik |
| Last Name | Olson |
| Address | 9564 W Plainfield Ave |
| City | Greenfield |
| State | WI |
| Province | |
| Zip/Postal Code | 53228 |
| Country | United States |
| erik@olson.pair.com | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Erik - Olson |
| Date of Injury | 02/08/1971 |
| Type of Injury | Obstetric |