| Church/Organization | |
| Preferred First Name | |
| Street Address | 4329 Rosewood Ave |
| City | Jacksonville |
| Postal/Zip Code | 32207 |
| Website | |
| Home Phone |
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Married |
| Length of Marriage | 15 years, 10 months ago |
