| Street | Avenida Amazonas, 1973 - Centro | ||
| City/Town | Parintins | ||
| State/Province/Region | Amazonas | ||
| Zip/Postal Code | 69151-260 | ||
| Phone Number | (92) 8413-9736 | ||
| Country | Brazil |
| Full Name | Dr. Alexa Burgos | ||
| Gender | female | ||
| Birthday | 1976-06-23 | ||
| Social Security Number | 31052764916 |
| Credit card brand | American Express | ||
| Credit card number | 343037416384731 | ||
| Expire | 2027/11 | ||
| CVV | 173 |