| Contact Information | |
|---|---|
| First Name | Nate |
| Last Name | Hagen |
| Address | 9025 N. 325th Street |
| City | Wheeler |
| State | IL |
| Province | |
| Zip/Postal Code | 62479 |
| Country | United States |
| Home Phone | 618 - 554-2771 |
| Work Phone | 618 - 783- 3718 |
| Fax | |
| hagens1@netzero.net | |
| Alternate Email | |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Nate - Hagen |
| Date of Injury | 02/07/1973 |
| Type of Injury | Obstetric |