We had dinner here twice while we were attending a convention at the Rio. Compared with the other places we dined at the Rio, this was a stand out. In general, though, it was a fairly average Italian restaurant. Prices were a bit high, most likely because the restaurant is in a casino.
We made reservations both nights and were seated promptly - we definitely chose times before the dinner rush started. Service was similarly prompt and attentive. The wait staff helped with menu selections and based on their recommendations we split the chicken parm the first night. When paired with a side of spaghetti (which was incredibly overpriced given the portion size) and a salad it was more than enough for the both of us. The next dinner we both tried the meatballs, which had a nice taste to them and were accompanied with a light sauce.
Another benefit to eating "early" (6-7 pm time frame): The music was at a tolerable level. We were worried about the noise when we first read the Yelp reviews, but it wasn't an issue when we were there. They apparently gradually turn up the volume as the evening draws on, so if you want to be able to chat with your dining companions, you might want to dine before things get too loud.
They do have a person going table to table asking if you would like your picture taken. That might be a turn off to some people, but it didn't bother us. The woman was very friendly and we chatted for a while. From what we saw from other tables, she wasn't high pressure: Tell her "no thanks" and she is off to another table.
We'd eat here again if we were ever in the Rio.