| Street | Poznanska 31 | ||
| City/Town | Leszno | ||
| State/Province/Region | Leszno | ||
| Zip/Postal Code | 64-100 | ||
| Phone Number | 65 520 70 14 | ||
| Country | Poland |
| Full Name | mgr dr Ewelina Kaźmierczak | ||
| Gender | female | ||
| Birthday | 1977-07-13 | ||
| Social Security Number | 89031188815 |
| Credit card brand | Unionpay | ||
| Credit card number | 6277817154977953 | ||
| Expire | 2029/11 | ||
| CVV | 033 |