| Contact Information | |
|---|---|
| First Name | Laryssa |
| Last Name | Summers |
| Address | 1135 Calvin Ave |
| City | Muskegon |
| State | MI |
| Province | |
| Zip/Postal Code | 49442 |
| Country | United States |
| Work Phone | 231 - 733-5020 |
| Fax | 231-737-2532 |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Laryssa - Summers |
| Date of Injury | 11/07/68 |
| Type of Injury | Obstetric |