| Street | 4950 Breton SE | ||
| City/Town | Kentwood | ||
| State/Province/Region | Michigan | ||
| Zip/Postal Code | 49508 | ||
| Phone Number | (616) 784-2007 | ||
| Country | United States |
| Full Name | Sallie Wisozk MD | ||
| Gender | female | ||
| Birthday | 1975-04-24 | ||
| Social Security Number | 343-11-1980 |
| Credit card brand | Voyager | ||
| Credit card number | 8699957832741300 | ||
| Expire | 2031/9 | ||
| CVV | 548 |