| Contact Information | |
|---|---|
| First Name | Connie |
| Last Name | Smith |
| State | MO |
| Home Phone | 573 - 388-1776 |
| Work Phone | - |
| Fax | |
| scottcon97@charter.net | |
| Alternate Email | |
| Website Address | |
| Gender | Female |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Connie - Smith |
| Date of Injury | 07/13/1970 |
| Type of Injury | Obstetric |