| Street | 9722 U.S. 192 | ||
| City/Town | Clermont | ||
| State/Province/Region | Florida | ||
| Zip/Postal Code | 34714 | ||
| Phone Number | (863) 424-7503 | ||
| Country | United States |
| Full Name | Dr. Tom Lueilwitz Sr. | ||
| Gender | male | ||
| Birthday | 1984-01-16 | ||
| Social Security Number | 551-99-2248 |
| Credit card brand | Visa | ||
| Credit card number | 4485820558505027 | ||
| Expire | 2031/12 | ||
| CVV | 286 |