| Street | Jalan Mohammad T. Haryono No.138 | ||
| City/Town | Balikpapan | ||
| State/Province/Region | Kalimantan Timur | ||
| Zip/Postal Code | 76128 | ||
| Phone Number | (0542) 765280 | ||
| Country | Indonesia |
| Full Name | Edi Harsaya Latupono S.Farm | ||
| Gender | male | ||
| Birthday | 1972-06-01 | ||
| Social Security Number |
| Credit card brand | Voyager | ||
| Credit card number | 8699897499935292 | ||
| Expire | 2028/3 | ||
| CVV | 615 |