Gill, A Wilson[?]

Reference Number: 
SMC/3/4/1/5 2:4
Name of Practitioner (Surname): 
Gill
Christian Names in Full: 
A Wilson[?]
Address: 
Chatterley Cottage, Hanley,
City/Town: 
Stoke-on-Trent
Date Signed: 
13/07/1916
Additional Information: 
Letter only; has moved to England and filled out the English equivalent form.