| Street | 1842 S 2000 W #2 | ||
| City/Town | Syracuse | ||
| State/Province/Region | Utah | ||
| Zip/Postal Code | 84075 | ||
| Phone Number | (801) 774-7540 | ||
| Country | United States |
| Full Name | Prof. Elmer Olson DDS | ||
| Gender | male | ||
| Birthday | 1973-05-18 | ||
| Social Security Number | 525-99-8294 |
| Credit card brand | American Express | ||
| Credit card number | 346711855970609 | ||
| Expire | 2031/12 | ||
| CVV | 566 |