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Organization
FACIAL PLASTIC & LASER SURGERY
Active
Organization
FACIAL PLASTIC & LASER SURGERY
Active
Other names
Facial Plastic & Laser Surgery Center, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT J TUDOR II (CHIEF EXECUTIVE OFFICER)
(309) 589-8053
Entity
Organization
Contact information
Practice address
7301 N KNOXVILLE AVE, PEORIA, IL 61614-2017
(309) 589-3233
(309) 689-0312
Mailing address
7301 N KNOXVILLE AVE, PEORIA, IL 61614-2017
(309) 589-3233
(309) 689-0312
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
IL
Other
Enumeration date
12/18/2006
Last updated
07/21/2022
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