| Street | N88W15483 Main St | ||
| City/Town | Menomonee Falls | ||
| State/Province/Region | Wisconsin | ||
| Zip/Postal Code | 53051 | ||
| Phone Number | (262) 253-9889 | ||
| Country | United States |
| Full Name | Dr. Burdette Shields | ||
| Gender | female | ||
| Birthday | 1975-12-23 | ||
| Social Security Number | 058-02-1446 |
| Credit card brand | Voyager | ||
| Credit card number | 8699329895370031 | ||
| Expire | 2030/2 | ||
| CVV | 525 |