| Street | 125 Main St | ||
| City/Town | Westport | ||
| State/Province/Region | Connecticut | ||
| Zip/Postal Code | 06880 | ||
| Phone Number | (203) 454-9911 | ||
| Country | United States |
| Full Name | Dr. Fausto Cruickshank | ||
| Gender | male | ||
| Birthday | 1981-04-08 | ||
| Social Security Number | 526-99-8507 |
| Credit card brand | JCB | ||
| Credit card number | 3586815031364828 | ||
| Expire | 2029/4 | ||
| CVV | 523 |