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Brain
Resource
the brain lesoulte cento
Applied Neuroscience & Personalized Medicine
Center
263 West End Ave Suite #1D
New York, NY 10023
April 9th 2014
Patient:
We have charged you a deposit for Neuropsychological testing of $3,500.00. Please
be advised that this charge is nonrefundable If you are okay with these conditions please
sign your name below on the line.
Thank You!
Dr.Kamran Fallahpour
Brain Resource Center
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EFTA00306962