Looks like a real Four Queens and a real Golden Nugget slot token may have been used to create this item. Perhaps sandwiching a blank slug between the two tokens and using a press or vice, the reverse impression of both were transferred to the one slug.

Highly unlikely to have happened at the mint, as the Master Dies would have to have been used, but then the Golden Nugget Master Die probably would have been centered correctly.

That's the way it looks to me.

Jim