| Street | 6344 Cypress Gardens Blvd | ||
| City/Town | Winter Haven | ||
| State/Province/Region | Florida | ||
| Zip/Postal Code | 33884 | ||
| Phone Number | (863) 324-3663 | ||
| Country | United States |
| Full Name | Mrs. Felipa Champlin MD | ||
| Gender | female | ||
| Birthday | 1970-04-18 | ||
| Social Security Number | 603-87-8871 |
| Credit card brand | Mastercard | ||
| Credit card number | 5197535217287165 | ||
| Expire | 2028/2 | ||
| CVV | 506 |