| Street | 815 Mayfield Rd | ||
| City/Town | Grand Prairie | ||
| State/Province/Region | Texas | ||
| Zip/Postal Code | 75052 | ||
| Phone Number | (972) 264-5193 | ||
| Country | United States |
| Full Name | Dr. Daniela Kuphal | ||
| Gender | female | ||
| Birthday | 1971-11-08 | ||
| Social Security Number | 460-99-5847 |
| Credit card brand | Discover | ||
| Credit card number | 6011308932271456 | ||
| Expire | 2030/9 | ||
| CVV | 772 |