| Contact Information | |
|---|---|
| First Name | joselline |
| Last Name | miro |
| Address | 411 e washington st apt 1 |
| City | West Chester |
| State | PA |
| Province | |
| Zip/Postal Code | 19380 |
| Country | United States |
| Home Phone | 484 - 888 |
| Work Phone | 8397 - |
| Fax | |
| isiabi24@aol.com | |
| Alternate Email | larubiajm@yahoo.com |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | joselline - miro |
| Date of Injury | 05/16/2008 |
| Type of Injury | Traumatic |