| Contact Information | |
|---|---|
| First Name | CONNIE |
| Last Name | SMITH |
| Address | 2823 LEAR DR |
| City | CAPE GIRARDEAU |
| State | MO |
| Province | |
| Zip/Postal Code | 63701 |
| Country | United States |
| Home Phone | 573 - 576-4071 |
| Work Phone | - |
| Fax | |
| scottcon97@charter.net | |
| Alternate Email | |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | CONNIE - SMITH |
| Date of Injury | 7/13/1970 |
| Type of Injury | Obstetric |