| Street | 1400 Grant Ave | ||
| City/Town | Winston-Salem | ||
| State/Province/Region | North Carolina | ||
| Zip/Postal Code | 27105 | ||
| Phone Number | (336) 703-4168 | ||
| Country | United States |
| Full Name | Dr. Jeanne Borer | ||
| Gender | female | ||
| Birthday | 2000-06-29 | ||
| Social Security Number | 266-99-4410 |
| Credit card brand | American Express | ||
| Credit card number | 370930813357860 | ||
| Expire | 2029/6 | ||
| CVV | 141 |