i • , Brain
Resource
t Center
263 West End Ave Suite #1D
New York, NY 10023
April 9th 2014
Patient:
We have charged you a deposit for I 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.Katnrun Fallahpour
Brain Resource Center
1
EFTA_R1_02213325
EFTA02725776
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