| Street | Jalan Cirebon No.76A | ||
| City/Town | Kota Medan | ||
| State/Province/Region | Sumatera Utara | ||
| Zip/Postal Code | 20212 | ||
| Phone Number | (061) 4561234 | ||
| Country | Indonesia |
| Full Name | Oni Kusmawati | ||
| Gender | female | ||
| Birthday | 1975-11-28 | ||
| Social Security Number |
| Credit card brand | Unionpay | ||
| Credit card number | 6297583081762928 | ||
| Expire | 2028/4 | ||
| CVV | 380 |