| Street | Aleja Krakowska 266 | ||
| City/Town | Warszawa | ||
| State/Province/Region | Warszawa | ||
| Zip/Postal Code | 02-210 | ||
| Phone Number | 22 575 28 00 | ||
| Country | Poland |
| Full Name | dr doc. Piotr Wieczorek | ||
| Gender | male | ||
| Birthday | 1984-05-16 | ||
| Social Security Number | 88052441002 |
| Credit card brand | American Express | ||
| Credit card number | 371474787939618 | ||
| Expire | 2030/10 | ||
| CVV | 991 |