| Street | 17976 Judicial Rd | ||
| City/Town | Lakeville | ||
| State/Province/Region | Minnesota | ||
| Zip/Postal Code | 55044 | ||
| Phone Number | (952) 435-7600 | ||
| Country | United States |
| Full Name | Johanna Beatty PhD | ||
| Gender | female | ||
| Birthday | 1977-09-30 | ||
| Social Security Number | 145-23-7445 |
| Credit card brand | EnRoute | ||
| Credit card number | 2014839817955512 | ||
| Expire | 2028/12 | ||
| CVV | 298 |