| Church/Organization | |
| Preferred First Name | |
| Street Address | 17831 137th Ave |
| City | Jamaica |
| Postal/Zip Code | 11434 |
| Mobile Phone | |
| Website | |
| Home Phone |
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Married |
| Length of Marriage | 16 years, 11 months ago |
