| Street | Swietych Cyryla i Metodego 3 | ||
| City/Town | Zielona Gora | ||
| State/Province/Region | Zielona Gora | ||
| Zip/Postal Code | 65-980 | ||
| Phone Number | 68 323 15 01 | ||
| Country | Poland |
| Full Name | dr Szymon Kowalski | ||
| Gender | male | ||
| Birthday | 1986-05-20 | ||
| Social Security Number | 73072545612 |
| Credit card brand | Diners Club | ||
| Credit card number | 3838205667204090 | ||
| Expire | 2028/8 | ||
| CVV | 704 |