| Street | Mueang Phayao District |
| City/Town | ตำบลเวียง |
| State/Province/Region | จังหวัดพะเยา |
| Zip/Postal Code | 56000 |
| Phone Number | 054 411 120 |
| Country | Thailand |
| Latitude | 19.172225 |
| Longitude | 99.902725 |
| Full Name | Lucienne Wilderman DVM |
| Gender | female |
| Birthday | 1971-03-18 |
| Social Security Number |
| Credit card brand | EnRoute |
| Credit card number | 2149327312342939 |
| Expire | 2029/1 |
| CVV | 806 |