| Full Name | 小泉 香織 |
| Gender | female |
| Birthday | 1977-09-05 |
| Social Security Number |
| Street | 147-18 Ishigaki |
| City/Town | 石垣市 |
| State/Province/Region | 沖縄県 |
| Zip/Postal Code | 907-8501 |
| Phone Number | 0980-82-8135 |
| Country | Japan |
| Latitude | 24.346833 |
| Longitude | 124.160478 |
| Credit card brand | American Express |
| Credit card number | 344032376671713 |
| Expire | 2028/6 |
| CVV | 526 |