| Street | 3260 Providence Dr | ||
| City/Town | Anchorage | ||
| State/Province/Region | Alaska | ||
| Zip/Postal Code | 99508 | ||
| Phone Number | (907) 569-8810 | ||
| Country | United States |
| Full Name | Dr. Lucie Wiza | ||
| Gender | female | ||
| Birthday | 1988-09-19 | ||
| Social Security Number | 006-11-0694 |
| Credit card brand | Diners Club | ||
| Credit card number | 3004146035309377 | ||
| Expire | 2027/8 | ||
| CVV | 148 |