| Contact Information | |
|---|---|
| First Name | Barry |
| Last Name | Kochel |
| Address | 1714 south 5th Ave. |
| City | Lebanon |
| Province | |
| Zip/Postal Code | 17042 |
| Country | United States |
| Work Phone | - |
| Fax | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Barry - Kochel |
| Date of Injury | 3/1/44 |
| Type of Injury | Obstetric |