| Street | 3285 E Andy Devine Ave | ||
| City/Town | Kingman | ||
| State/Province/Region | Arizona | ||
| Zip/Postal Code | 86401 | ||
| Phone Number | (928) 757-4315 | ||
| Country | United States |
| Full Name | Dr. Corine Simonis Jr. | ||
| Gender | female | ||
| Birthday | 1971-12-26 | ||
| Social Security Number | 432-99-6760 |
| Credit card brand | Visa | ||
| Credit card number | 4716700632199040 | ||
| Expire | 2027/10 | ||
| CVV | 069 |