| Contact Information | |
|---|---|
| First Name | Parth |
| Last Name | Panchal |
| Address | N-48,Nandanvan Appt-IV,Nr.Prernatirth Derasar |
| City | Ahmedabad |
| State | CA |
| Province | Gujarat |
| Zip/Postal Code | 380015 |
| Country | India |
| Work Phone | - |
| Fax | |
| Gender | Male |
| Injury Information | |
| The injured person is | Child |
| Name of Injured | Parth - Panchal |
| Date of Injury | 09/18/2001 |
| Type of Injury | Obstetric |