| Street | 76 Professional Plaza | ||
| City/Town | Rexburg | ||
| State/Province/Region | Idaho | ||
| Zip/Postal Code | 83440 | ||
| Phone Number | (208) 356-4585 | ||
| Country | United States |
| Full Name | Ted Smitham | ||
| Gender | male | ||
| Birthday | 1971-11-16 | ||
| Social Security Number | 149-23-5642 |
| Credit card brand | Visa | ||
| Credit card number | 4539412148774259 | ||
| Expire | 2027/1 | ||
| CVV | 044 |