| Street | Ignacego Lukasiewicza 1 | ||
| City/Town | Lubin | ||
| State/Province/Region | Lubin | ||
| Zip/Postal Code | 59-300 | ||
| Phone Number | 601 315 708 | ||
| Country | Poland |
| Full Name | dr doc. Jacek Wieczorek | ||
| Gender | male | ||
| Birthday | 1982-02-03 | ||
| Social Security Number | 76021126951 |
| Credit card brand | JCB | ||
| Credit card number | 3550131519726344 | ||
| Expire | 2029/3 | ||
| CVV | 650 |