| Street | 1 Park Pl | ||
| City/Town | Elmira | ||
| State/Province/Region | New York | ||
| Zip/Postal Code | 14901 | ||
| Phone Number | (607) 735-1724 | ||
| Country | United States |
| Full Name | Foster Altenwerth DDS | ||
| Gender | male | ||
| Birthday | 1989-09-18 | ||
| Social Security Number | 504-45-3300 |
| Credit card brand | Diners Club | ||
| Credit card number | 3022227648323712 | ||
| Expire | 2028/3 | ||
| CVV | 175 |