| Contact Information | |
|---|---|
| First Name | Carly |
| Last Name | Smith |
| Address | 6255 Beechtree Dr #2207 |
| City | West Des Moines |
| State | IA |
| Province | |
| Zip/Postal Code | 50266 |
| Country | United States |
| smith24s1@hotmail.com | |
| Alternate Email | smith24s1@hotmail.com |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Carly - Smith |
| Date of Injury | 09/06/1982 |
| Type of Injury | Obstetric |