| Street | Mueang Nakhon Sawan District |
| City/Town | นครสวรรค์ |
| State/Province/Region | จังหวัดนครสวรรค์ |
| Zip/Postal Code | 60000 |
| Phone Number | 056 222 631 |
| Country | Thailand |
| Latitude | 15.701691 |
| Longitude | 100.136738 |
| Full Name | Julianne Jakubowski MD |
| Gender | female |
| Birthday | 1992-12-15 |
| Social Security Number |
| Credit card brand | American Express |
| Credit card number | 379650215544219 |
| Expire | 2028/2 |
| CVV | 809 |