| Street | 1732 E 66th St | ||
| City/Town | Richfield | ||
| State/Province/Region | Minnesota | ||
| Zip/Postal Code | 55423 | ||
| Phone Number | (612) 861-7140 | ||
| Country | United States |
| Full Name | Dr. Lavada Mosciski Sr. | ||
| Gender | female | ||
| Birthday | 1974-12-14 | ||
| Social Security Number | 508-57-4597 |
| Credit card brand | Unionpay | ||
| Credit card number | 6248728289398302 | ||
| Expire | 2031/10 | ||
| CVV | 958 |