| Contact Information | |
|---|---|
| First Name | myrtis |
| Last Name | moss |
| Address | 108 kennedy st |
| City | pell city |
| State | AL |
| Province | |
| Zip/Postal Code | 35128 |
| Country | United States |
| Home Phone | 205 - 4734951 |
| Work Phone | 205 - 8143527 |
| Fax | 2048143676 |
| mlmoss2000@yahoo.com | |
| Alternate Email | |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | |
| Name of Injured | - |
| Date of Injury | |
| Type of Injury | Obstetric |