| Contact Information | |
|---|---|
| First Name | Sandra |
| Last Name | Rivera |
| Address | 10484 Polo lake drive West # 101 |
| City | Wellington |
| State | FL |
| Province | |
| Zip/Postal Code | 33414 |
| Country | United States |
| Home Phone | 561 - 699-1702 |
| Work Phone | - |
| Fax | |
| sandy101267@yahoo.com | |
| Alternate Email | miguelrivera35@comcast.net |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Child |
| Name of Injured | Julian - Rivera |
| Date of Injury | 11/13/1998 |
| Type of Injury | Obstetric |