| Street | 3900 W Powell Blvd | ||
| City/Town | Gresham | ||
| State/Province/Region | Oregon | ||
| Zip/Postal Code | 97030 | ||
| Phone Number | (503) 405-1478 | ||
| Country | United States |
| Full Name | Miss Suzanne Leuschke DDS | ||
| Gender | female | ||
| Birthday | 1984-12-17 | ||
| Social Security Number | 227-99-5503 |
| Credit card brand | Unionpay | ||
| Credit card number | 6249859893533635 | ||
| Expire | 2027/8 | ||
| CVV | 711 |